Objective To observe the therapeutic effect of rhubarb combined with Probiotics for treatment of patients with severe acute pancreatitis (SAP) accompanied by acute lung injury (ALI). Methods A prospective randomized controlled trial was conducted. Sixty patients with SAP and ALI were randomly divided into a rhubarb group and a combination of rhubarb and Probiotics group (combined group), 30 cases in each group. Both groups were treated with conventional therapy. On that therapeutic base, the patients in rhubarb group were treated with rhubarb 3 g·kg-1·d-1 (Raw rhubarb in boiling water 200 mL was cooked for 30 minutes, then the decoction was divided into two parts to be infused through nasal jejunal tube, retaining for 1 hour);while in the combined group, beside the above rhubarb therapy, the patients were additionally given Probiotics [Clostridium butyric acid:Chang Lekang capsule, once 1 grain (0.42 g), twice a day] through nasal jejunal tube. The therapeutic course was 14 days in the two groups. The plasma endotoxin levels, oxygenation index, and acute physiology and chronic health evaluationⅡ(APACHEⅡ) score were observed before and after treatment for 7 days and 14 days, respectively. After treatment for 30 days, the time of intestine functional recovery and mechanical ventilation, number of damaged organs, number of infectious sites, number of pancreatic pseudocysts, length of intensive care unit (ICU) stay and 30-day fatality rate were observed in the two groups. Results With the prolongation of treatment, the plasma level of endotoxin and APACHEⅡscore in the two groups were gradually reduced, and the oxygenation index was gradually increased after treatment for 7 days and 14 days in the two groups compared with those before treatment, and there were statistically significant differences in above indexes on the 14th day after treatment between combined group and rhubarb group [endotoxin (μg/L): 19.16±1.90 vs. 21.20±1.05, oxygenation index (mmHg, 1 mmHg = 0.133 kPa): 369.50±5.45 vs. 341.50±7.36, APACHE Ⅱscore:11.84±0.60 vs. 13.00±0.86, P<0.05 or P<0.01]. The length of intestine functional recovery in the combined group was longer than that in the rhubarb group (days: 5.63±1.75 vs. 5.02±1.54), the number of damaged organs (2.08±0.74 vs. 2.70±1.11), the number of infectious sites (1.93±0.64 vs. 2.23±0.83), the number of pancreatic pseudocysts (1.22±0.34 vs. 1.63±0.11) and the mortality rate [10.0%(3/30) vs. 13.3%(4/30)] in the combined group were lower than those of the rhubarb group, but there were no statistically significant differences between two groups (all P > 0.05). The times of mechanical ventilation (days: 13.40±1.76 vs. 15.60±1.28) and the length of ICU stay (days:16.13±1.25 vs. 17.63±1.30) were significantly shorter in combined group than those in rhubarb group (both P<0.05). Conclusion Rhubarb combined with Probiotics for treatment of patients with SAP and ALI can promote their recovery of lung function and shorten their length of ICU stay.

Objective To evaluate the outcome of open repair of Bankart lesion in the treatment of anterior instability of shoulder.Methods From March 2001 to June 2005,34 cases (36 shoulders) of anterior instability of shoulder underwent open repair of Bankart lesion.Twenty-seven shoulders with Bankart injury were diagnosed by CT scan.Nine shoulders were diagnosed as ALPSA(anterior labrum periosteal sleeve avulsion).Twenty-five shoulders presented with anterior instability only,and 11 combined anterior and inferior instability.Twenty-seven cases had a definite history of injury.Twelve cases presented with Hill-Sachs sign.We used open incision to repair lesions to the capsule glenoid labrum complex with suture anchors.Results The average duration of follow-up was 2.2 years (six months to four years).By Walch-Duplay score system,the good to excellent rate was 86.1%,the moderate rate 8.3%,and the poor rate 5.6%.Redislocation occurred in one case after operation due to injury.The rate of recurrence was 3%.Conclusion Open repair of Bankart lesion in the treatment of anterior shoulder in- stability can lead to good recovery of shoulder function,few complications and a low rate of recurrence.

Objective To explore the pattern of functional reorganization in the cortex after corticospinal tract ( CST) injury and its relationship with the recovery of upper limb motor function. Methods Fifteen patients with complete paralysis on one side after acute cerebral infarction were studied. Within 1 week after the onset, func-tional magnetic resonance imaging ( fMRI ) and diffusion tensor tractography ( DTT) were performed in parallel with timed finger flexion and extension movements in all subjects. The number of nerve fibers in corticospinal tract ( CST) in the affected and healthy sides was measured by using Dtv.Ⅱ. R2 software. One and three months later, fMRI was performed while the affected fingers were flexed and extended passively and any cortical activation was observed. In addition, Fugl-Meyer arm motor function scores were assessed one week, one month and three months after the stroke. Results According to the reconstructed nerve fiber number in CST on the affected side, the patients were classified into three types. Type I:the number of newly-built CST nerve fibers is more than 2/3 of that on the healthy side;type II:the ratio is between 1/3 and 2/3;and type III:the ratio is less than 1/3. For typeⅠpatients, blood oxygenation level-dependent fMRI ( bold-fMRI) showed initial activation of the bilateral sensorimotor cortex ( SMC) and the sup-plementary motor area ( SMA) on the affected side. That was followed by a gradual decrease in the activity in the healthy SMC and an increase in the affected SMC at 1 and 3 months. Among the type II patients bold-fMRI indicated activation of the SMC and SMA on the affected side initially, significant activation of the bilateral SMC and SMA one month later and then stronger activation in the SMC on the healthy side and a weakening of activation in the SMC on the affected side. For typeⅢpatients, initially the SMA and the posterior parietal cortex were found to be slightly ac-tivated. One month later SM1 on the unaffected side was slightly activated, and 3 months later neither the SMC nor the SMA on either side was activated. One week after the onset, the average upper extremity FM scores of the three types of subjects were not significantly different. After one month the three groups′averages were all significantly dif-ferent from one another. But after three months the averages for types I and II were again not significantly different, but significantly better than the average of the type III patients. Conclusion Different CST injuries induce different modes of cortical reorganization. The reorganization is a dynamic process, and different activation patterns are closely correlated with clinical prognosis.

Objective To investigate the correlation between setup error and couch position error in radiotherapy.Methods A total of 25 patients with thoracic and abdominal tumors who recently finished image-guided radiotherapy were randomly selected.The data on couch position during treatment were obtained through the record validation system, and then the couch position error was calculated.The Pearson correlation analysis was used to investigate the correlation between setup error and couch position error during treatment.Results In the ≥5 setup errors among the 25 patients, the correlation coefficient between random setup error and random couch position error was 0.83(P=0.00), and the correlation coefficient between systematic setup error and systematic couch position error was 0.36(P=0.11).Conclusions In radiotherapy, the random setup error is highly correlated with the random couch position error, while a moderate or low correlation exists between the systematic setup error and the systematic couch position error.

Objective To summarize the clinical experiences of video-mediastinoscopy followed by stenting procedure in treating the superior vena cava syndrome (SVCS),and to investigate their application significant.Methods Nine patients with SVCS without clear histologic diagnosis before procedure were reviewed retrospectively,who were admitted into hospital from November 2007 to October 2013.All of 9 patients were received video-mediastinoscopy and they did not performed pathological check.They were placed the endovascular stent.Results Video-mediastinoscopy followed by stenting procedure 6 cases,parasternal TN mediastinoscopy 2 cases,joint neck and parasternal TV mediastinoscopy 1 case.Nine cases have received a clear pathological diagnosis.There was no death case in-hospital.The operative complication was hemorrhage of 1 case.The cubital venous pressures were (18.6±5.1) cmH2O at stending,(13.5±3.3) cmH2O,(11.3±2.5) cmH2O,(10.3± 2.0) cmH2O at 24,48,72 h after stending,and down to the normal at 72 h (F =67.245,P ＜0.01).The clinical symptoms were obviously relieved.All of them were remained free from SVCS during the follow-up.Conclusion The hybrid procedure of video-mediastinoscopy followed by stenting placement is a highly effective and safe treatment.It can accurately provide informations on diagnosis and treatment.

Objective To compare 18F-FDG、11C-MET and 11C-CHO PET/CT in rat C6 glioma and inflammation models and observe their correlations with HIF-1α and VEGF expressions.Methods Thirtytwo male Wistar rats were included to bear both C6 glioma and turpentine oil-induced acute inflammation (AI).18F-FDG,11C-MET and 11C-CHO PET/CT were performed on rats.The SUVmax ratios of tumor-tomuscle (T/M),AI-to-muscle (AI/M) and tumor selectivity index (SI) were calculated.One-way analysis of variance and two-sample t test were used for statistical analyses.HIF-1α and VEGF expression was detected by immunohistochemical staining.Spearman correlation analysis was performed to evaluate the relationship between T/M ratios and the expressions of HIF-1α or VEGF.Results T/M ratios of 18F-FDG,11 C-MET and 11C-CHO in C6 glioma were 6.89±2.53,2.75±0.87,2.73±1.01,and the AI/M were 4.77±2.21,1.75±0.66,2.23±0.90 respectively.The 18F-FDG and 11C-MET uptake between C6 glioma and AI were significantly different(tFDG =2.133,tMET =3.267,both P＜0.05).The SIMET was significantly higher than SIFDG(t =2.600,P＜0.05).The 11C-CHO uptake between tumor and inflammation showed no significant difference(t=1.537,P＞0.05).T/M ratios of 18F-FDG and 11C-MET were positively related to HIF-1α and VEGF expressions(rs =0.725,0.637,0.621,0.764,all P＜0.05).The T/M ratio of 11C-CHO related only to VEGF (rs =0.682,P＜0.05).Conclusions 18F-FDG and 11 C-MET PET/CT may differentiate C6 glioma from AI,and 11 C-MET PET/CT seems more tumor-selective.11C-CHO PET is less valuable for the differential diagnosis.The 18F-FDG and 11 C-MET uptake of C6 glioma may be related to tumor hypoxia.All the three tracers could reflect tumor angiogenesis,but with different sensitiveness.

Objective To explore the effect of keratinocyte growth factor(KGF)on the lung tissue and expres-sion of transforming growth factor - β1(TGF - β1 )in newborn rats with hyperoxia. Methods The 108 newborn SD rats were randomly divided into air group,hyperoxia group and KGF intervention group,and each group had 36 rats. The rats in every group were randomly divided into the 3,7,14 days subgroups,and each group had 12 rats. The rats in the hy-peroxia group and KGF intervention group were continually exposed to more than 950 mL/ L of oxygen box until the end of the experiment. KGF intervention group simultaneously undertook oxygen inhalation,hypodermic injection of 1 mg/ d recombinant human KGF(rhKGF)on the back on the first 3 days and 0. 5 mg/ d 3 days later till the end of the experi-ment. Air group and hyperoxia group were offered equivalent 9 g/ L saline. The rats in the air group took air. The sub -groups of the 3,7 and 14 days were cut for lung tissue in the corresponding time,observing lung tissue by light micro-scope for pathological changes and TGF - β1 protein expressed in the lungs was determined by immunohistochemistry. Results Air group sprout pulmonary alveolus on the 7th day,and the alveolaration finished on the 14th day,while hy-peroxia group had alveolar growth retardation and pulmonary fibrosis,but pulmonary fibrosis was not obvious in KGF in-tervention group. There was a significant difference on 7th day and 14th day between hyperoxia group and air group in TGF - β1(9. 43 ± 0. 64 vs 8. 62 ± 0. 52,P ﹤ 0. 05;9. 97 ± 0. 49 vs 8. 66 ± 0. 48,P ﹤ 0. 01). There was no significant difference between KGF intervention group and air group in TGF - β1(8. 67 ± 0. 55 vs 8. 56 ± 0. 43,8. 77 ± 0. 52 vs 8. 62 ± 0. 52,8. 81 ± 0. 47 vs 8. 66 ± 0. 48,all P ﹥ 0. 05). There's a significant difference on 7th day and 14th day be-tween hyperoxia group and KGF intervention group in TGF - β1(all P ﹤ 0. 05). Conclusions KGF can inhibit the pro-tein expression of TGF - β1 ,and this may be one of the possible mechanism underlying the protective effect of KGF a-gainst lung injury.

Acquired Immunodeficiency Syndrome ; psychology ; Humans ; Suicide

OBJECTIVETo explore the surgical method and its clinical effects of minimally invasive osteosynthesis on the treatment of complex ankle fractures.

METHODSFrom January 2007 to December 2011, 53 patients with complex ankle fractures were treated with minimally invasive osteosynthesis. There were 31 males and 22 females, with an average age of 38.2 years old (ranged, 18 to 65). According to the system of Lauge-Hansen, 32 fractures were supination external rotation injury (grade WV), 13 fractures were pronation external rotation (grade III or IV), 5 fractures were pronation abduction (grade III); and 3 fractures can not be classified due to serious comminution fracture of fibula. According to the system of Denis-Weber, there were 4 cases with type A, 34 cases with type B and 15 cases with type C. Seven cases were open fractures. The duration from injuries to operation ranged from 2 hours to 14 days with an average of 5 days. The sequence of reduction and fixation of ankle fractures was firstly posterior malleolus, then medial malleolus and lateral malleolus, and inferior tibiofibular syndesmosis lastly. The fractures of posterior malleolus were reduced and fixed through anterior ankle approaches; the fractures of medial and lateral malleolus were percutaneously fixed with bolts or blade plate or tensile force band; and inferior tibiofibular syndesmosis were firmly fixed if necessary. Baird-Jackson scoring system was used to evaluate clinical effects.

RESULTSForty-eight patients were followed up from 10 to 36 months with an average of 13 months. The fractures got healing with an average time of 12 weeks (ranged, 10 to 18). According to the Baird-Jackson scoring system, the mean score of ankle function was 94.7 +/- 4.2, and 28 cases obtained excellent results, 15 good, 3 fair and 2 poor. One case experienced superficial infections and was cured by changing dressings, 2 cases experienced fixed syndesmosis screw breakage.

CONCLUSIONThe surgical method of minimally invasive osteosynthesis can ensure the anatomical join restoration, protect the blood supply of fracture end, rebuild the function of ankle joint, obtain satisfactory clinical results in treating complex ankle fractures.

Adolescent ; Adult ; Aged ; Ankle Fractures ; Ankle Joint ; physiopathology ; surgery ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods

During the washing process of coarse bear gall powder extracts, it is necessary to adjust the amount of ethyl acetate according to the properties of raw materials, which aims to improving the yield and purity of the final product. In the research, using NIR spectra to reflect the comprehensive properties of coarse bear gall powder extracts, the process is optimized in a flexible way. Forty batches experiments are designed according to the weight ratio of ethyl acetate and coarse extracts of bear gall powder. The NIR spectra of the coarse extracts of bear gall powder are collected and processed using principal component analysis (PCA) method. The first 8 principal components combined with the amount of the ethyl acetate are used as the input variables, and calibration models are established to predict the yield and purity of the final product 30 batches are used as calibration set, which is used to establish the models, and other 10 batches are used as validation set, which is used for the performance appraisal of the established models. The correlation coefficients of the calibration, inner cross-validation and external validation for the purity model are 0.902, 0.896 and 0.883, respectively, and the RMSEC, RMSECV and RMSEP are 1.22%, 1.48% and 1.59%, respectively. The correlation coefficients of the calibration, inner cross-validation and external validation for the yield model are 0.921, 0.859 and 0.916, respectively, and the RMSEC, RMSECV and RMSEP are 1.39%, 1.65% and 1.53% respectively. This work demonstrated that NIR spectra combined with technology parameter could be used to predict the yield and purity of the final product. Using the established models, the most appropriate amount of the ethyl acetate can be determined according to the properties of the coarse bear gall powder extracts, and the yield and purity of the final product can be improved.
Acetates ; chemistry ; Animals ; Gallbladder ; chemistry ; Medicine, Chinese Traditional ; Powders ; chemistry ; Principal Component Analysis ; methods ; Spectroscopy, Near-Infrared ; methods ; Ursidae